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Pain And Dependence   Screening For Addiction In A Pain Setting   Dr Steve Gilbert Dr Alex Baldaccino
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Pain And Dependence Screening For Addiction In A Pain Setting Dr Steve Gilbert Dr Alex Baldaccino

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Lecture given to the North British Pain Association on 16th May 2008 by Dr Steve Gilbert and Dr Alex Baldaccino. In this talk, they discuss the assessment and screening of patients in the pain clinic …

Lecture given to the North British Pain Association on 16th May 2008 by Dr Steve Gilbert and Dr Alex Baldaccino. In this talk, they discuss the assessment and screening of patients in the pain clinic for evidence of drug dependence.

www.nbpa.org.uk

Published in: Health & Medicine

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  • Transcript

    • 1. Pain and Dependence: screening for addiction in a pain setting
        • North British Pain Association
        • May 2008
        • Drs Steve Gilbert and Alex Baldacchino
        • NHS Fife
    • 2. Overview
      • Drugs and dependence in a pain setting: what does the literature tell us
      • The process of change
      • Dependence
      • Assessment
      • Objective signs
    • 3. Historical Perspective
    • 4. Opiophobia!
      • The Hospice movement 1960’s
      • WHO Pain Ladder
      • BUT……
      • European Pain In Cancer 2007 (EPIC)‏
      • 50% had moderate to severe pain
      • Option of strong opioids not offered
      • 20% had no pain treatment
    • 5. PAIN IN EUROPE 2004
      • Strong opioids for non malignant pain
        • Ireland - 13%
        • Britain – 12%
        • Denmark -11%
        • Holland – 5%
        • France Germany & Poland - 4%
        • Spain - 1%
        • Italy - 0%
        • Britain had the highest proportion of patients on opioids - 50% on “weak opioids”
        • + 12% on “strong”
    • 6. Where are we now?
      • Do opiates improve pain & function in chronic pain?
      • Portenoy & Foley 1986 - YES!
      • BUT!
      • short term – focusing on pain score
      • Long term follow up not so optimistic
    • 7. The Danish experience
    • 8. Eriksen & the Danish Experience
      • Cross sectional census of population
      • Those on opiates had more pain
      • AND less ability
      • Mounting levels of prescription drug abuse
      • More rather than less health service utilisation
      • Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK. Critical
      • issues on opioids in chronic non-cancer pain. An epidemiological
      • study. Pain 2006;125:172–9
    • 9.  
    • 10. Good Advice?
    • 11. Problem Use and Dependence
      • Drug use terminology
      • What is problem use?
      • What is dependence?
      • The alcohol dependence syndrome
      • Relationship between problems and dependence
    • 12. Drinking and drug using careers
      • What is a drug-taking career?
      • Why do we need to know about drug taking careers?
      • Moving into and out of the drug-taking career
      • Does treatment alter drug and alcohol careers?
    • 13. The process of change
      • Why is it important to understand change?
      • How does it feel?
      • A process of change model
      • Motivational interviewing
    • 14. WHAT CAN I OFFER A NEWLY PRESENTING DRUG USER?
      • Accept your limits & define your philosophy / boundaries
      • What can I do?
      • What can’t I do?
      • What will I do?
      • What won’t I do?
      • With what do I need help?
      • Where can I get it?
    • 15. The Assessment Process
      • The drug & medical history
      • Examination
      • Screening for drug use
      • Therapeutic boundaries and goal setting
      • Objective investigations
    • 16. The Drug & Medical History
      • Why has the patient presented to you now?
      • How has the patient presented?
      • Screening: AUDIT and DUDIT
      • Assessment of their current drug use (last 4 weeks)‏
      • Past drug history
      • Previous treatments
      • Assessing risk-taking behaviour
      • Assessment of physical health
      • Assessment of psychological health and motivation
      • Assessment of social situation
    • 17. Examination
      • General state
      • Examination of the skin
      • Assessment of Resp & CVS systems
      • Abdominal examination
      • Musculoskeletal system
      • CNS
      • Special problems for women users
        • Contraception
        • Osteoporosis
    • 18. Objective signs for drug use
      • Why do this?
      • To confirm the patient is using drugs and which ones
      • To help decide on the treatment plan
      • For your medicolegal protection
      • For the patients protection
      • To help reduce street diversion
      • To encourage honesty
    • 19. Objective signs
      • Routine urinalysis
      • Routine bloods may be difficult
      • Hepatitis and other BBV serology
    • 20. Goal setting
      • Important to identify goals so that treatment has direction and focus
      • Clearly identified collaboratively with the patient
      • Specific, attainable and measurable split into short and long term
      • Help the patient to think about how these changes may be brought about
      • Assessment is a process and should be sequential and ongoing as an individuals needs develop
    • 21. WHAT CAN I OFFER A NEWLY PRESENTING DRUG USER?
      • Brief interventions
      • F eedback
      • R esponsibility
      • A dvice
      • M enu
      • E mpathy
      • S elf-efficacy